Guest Post – NHS Chaplains: Secularists keep getting it wrong
I find the National Secular Society (NSS) a frustrating bunch. Sometimes, they do a great job of opposing religious privilege, and sometimes their kneejerk opposition to anything that appears even slightly religious leads them into illiberality or simple factual error. Hospital chaplains are an example of this – they oppose them because they sound religious, with little or no understanding of what they actually do. Rather than attempt to tackle this issue myself, I asked a friend, Chiron, who happens to be a hospital chaplain, and he very kindly helped out with a rather more informed take on why chaplains aren’t the religious Trojan Horse the NSS are arguing against.
Here are Chiron’s thoughts on why the NSS have got it wrong.
Thanks to a freedom of information request some time ago by the National Secular Society, we now know that the NHS spends £29million a year on chaplaincy. Let’s naively take that figure at face value, but let’s also get some perspective on it. Last year, a UK citizen on median income paid about £2230 in National Insurance contributions, which we might also naively assume went towards paying for the NHS. Out of that £2230, our average citizen paid 61p towards NHS chaplaincy. Compare this with the £15.78 paid towards the cost of locum 
doctors (i.e. doctors who are employed on expensive contracts because the NHS can’t get its act together over out-of-hours working), or the £6.60 paid towards NHS management consultants.1 However, one of the most frequent criticisms made by some secularists of hospital chaplaincy isn’t about the money involved: it is that NHS chaplaincy is a religious service provided exclusively for a few religious people. Unfortunately for the secularists, this is just plain wrong.
This mistaken opinion seems to have been held not only by Dr Edward Presswood on Radio 4’s Today programme this week, but also by his interviewer, Justin Webb, who asked the question, ‘Is it the business of the NHS … to be providing chaplains, and indeed other efforts to give comfort to religious people …?’ Dr Presswood, for his part, not only seemed unable to distinguish between mature religious belief and a superstitious avoidance of the number 13, but stated that he thought chaplaincy was provided only for ‘one particular religious belief’.
If that were true, then of course NHS funded chaplaincy would be indefensible. But it’s not true. The hospital chaplains I know and have worked with spend only a minority of their time with people of explicit religious affiliation. Much more time is spent on people of no explicit religious belief, but whose illness has brought them to a place of uncertainty, anxiety, and questioning, and who ask the chaplain to accompany them through that experience. Far from being the narrow-minded purveyors of Bible-thumping religion often portrayed by some secularists, chaplains don’t proselytise (it’s against their code of conduct), and are bound by their professional standards to be open, accepting and non-judgemental to those who ask for their help. In my experience chaplains are likely to have well developed skills in secular ethics, philosophy, sociology and many other disciplines, and also often have a profound body of experience to draw on. Almost uniquely in the contemporary NHS, chaplains organise their time so as to give their patients the attention they need, rather than working strictly to timed appointments. I recently learned of a case where a chaplain was talking with a patient and their family. A doctor arrived, obviously in a hurry, ignored the presence of the chaplain, unceremoniously spent about two minutes telling the patient they were going to die, and left the room. The chaplain then spent most of the morning with that family as they began to find their way through the shock of their experience.
I won’t deny there are problems with NHS chaplaincy. I believe that largely because of a historically privileged position, chaplaincy is sometimes insufficiently professionalised in its approach. There are inconsistencies in provision and funding (why, for example, don’t we have more Humanist chaplains?), and despite years of discussion, there’s no firmly agreed programme of continuing professional education or compulsory registration. But these problems don’t feature in the arguments we’re currently hearing from secularists. They tend to argue simply that chaplaincy should be taken out of NHS hands altogether and, in effect, privatised by handing it over to religious organisations. My counter-argument is that this would make chaplaincy more narrowly religious, less helpful to patients, and virtually useless to NHS professionals and the institutions in which they work. A chaplain employed by a Church would see only patients who were members of that Church; a chaplain employed by the NHS is available for anyone. A chaplain employed by a Church would have no commitment or loyalty to the hospital they worked in. An NHS chaplain not only has that commitment and loyalty, but has an often explicit remit to help guide and challenge the institution when needed. The chaplain is also one of a usually small group of professionals whose role is to resist the tendency of modern technological biomedicine to see sick people merely as broken-down machines, and who try to affirm and promote the human values of good healthcare.
The bottom-line question on all sides of the discussion, however, is this: what does caring for the sick involve? If you believe that a sick person is qualitatively no different from a broken car engine, and that therefore the NHS is really only a Kwik-Fit repair centre for human beings, then cast your lot with the secularists and ask the Chancellor to refund your 61p each year. But if you believe that in addition to top-quality biomedical care, a sick person deserves to have someone with whom to discuss their decisions, anxieties and relationships, their past and their future, their nature as a complex being in a complex world – then is it just possible that your 61p a year might be worth it?
1 Calculations based on annual NHS budget of £106bn and median UK salary of £26,000.
Image by xenia, used under MorgueFile License
21 responses to “Guest Post – NHS Chaplains: Secularists keep getting it wrong”
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- - June 20, 2012
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Recovering Agnostic 
I’m sorry but this argument is flawed. Specifically what service does the chaplaincy provide that highly trained counsellors and therapists (who are very often employed by the NHS) do not or cannot? What specific training do they have that makes them better than the average therapist?
If – as the guest poster suggests – these people are merely therapists who just happen to wear dog collars or other religious symbols and trinkets, why the need to dress it up in religious symbolism at all?
I find it ludicrous to suggest that the religious element of a chaplaincy is unimportant when these people are being employed specifically for their religious beliefs. Would you advertise a job as requiring an HGV license for a job where the employee would never use an HGV an exclude all of those people who do not have HGV licenses?
Finally, how can we justify the extra expense for a therapy service that is arguably superfluous to the needs of the NHS?
As someone who’s husband is currently in hospital, I can say that there is no one currently employed by the NHS, apart from the chaplain, who can fulfill that post. I was very distressed about my husband’s condition and the chaplain who was around CCU, he spends time there every day, just sat with me, provided tissues, a shoulder to cry on and a professional, non medical professional support. he understood what was happening enough to reassure me that my husband’s response to his situation was normal and not alarming and he could stay as long as I needed him. He never once mentioned God, although he wore a dog collar, but he was just a calming presence.
My faith or lack of it mattered not a jot to this caring young man, my distress was what concerned him and he provided comfort in a way that no other hospital professional could, being there at the moment I needed, not a week or a month later. 61pence extremely well spent.
I agree with procrastin8or, above, and would also like to add this thought:
Until you can show me real evidence that god(s) exist(s), and, if so, that any existing religious creed reflects the wishes of that god, I’m with Dr Presswood on that one.
Also, if such therapy is needed, I’d like the therapist be qualified as a therapist, regardless of any divinity degree or such that they might have.
Dr Preswood was not speaking for the National Secular Society.
The NSS does not call for chaplains to be expelled from hospitals, it asks that they pay their own way – or their church or mosque pays for them. There has been no satisfactory explanation yet as to why the NHS should pay the salaries and costs of clergypeople. In Wales a campaign is underway to get churches and religious organisations to set up charitable trusts to raise money to support chaplains and take the burden off health authorities who are now sacking nurses and doctors because they can’t afford them. Priest in hospitals should pay their own way and leave the budgets for the purpose of primary health care.
Terry, do you have some sort of batsignal that alerts you to mentions of the NSS? 😉
Seriously, I’d be happy to edit the text to make it clear that Dr Presswood was speaking on his own account. Please let me know if you’d like me to do that.
Wow – there’s about another half a dozen blog entries in the comments so far. A quick response to Terry Sanderson and to one of procrastin8or’s points.
First, Terry Sanderson – you’ll see I dealt briefly in the penultimate paragraph of my post with the question of funding. Basically, the issue is one of accountability and commitment. As sociologist Tony Walter has pointed out, the nature of chaplaincy work means that chaplains tend to exist on the margins of their faith communities – I can’t imagine a Church (or any other faith group) allowing one of its ministers to do the majority of chaplaincy work which is with non-religious people.
procrastin8or – the chaplain/counsellor question is commonly asked and, I’ll admit, not easily dealt with briefly. Counselling in the NHS usually comes under psychiatric/psychological care and is called on where there’s an identifiable psychological condition to be treated. The help that chaplains give is rather different in kind – we tend not to deal in concepts such as pathology and treatment. Where I work, the chaplaincy and counselling/psychology teams regularly refer patients to each other when we think it’s appropriate. I’ll semi-flippantly point out that we might also be cheaper! (I can’t find any figures for how much the NHS spends on counselling, though I do recall a figure of about £230million on antidepressant medication.) And the reason that most chaplains are ministers (though not all, by any means) is for the times when we do have to act in that capacity.
Is grief counselling (for the dying or for the family) not not psychological care? I feel you are being disingenuous to suggest that counsellors are entirely concerned with mental health issues.
You might be cheaper than highly trained counsellors but that doesn’t justify the extra expense of the service you provide that could easily be provided within the framework of the counselling service. If a counsellor can refer a patient to you, what is to stop them saying “sorry but grief counselling is my speciality… can I refer you to Mr Smith who is better qualified at counselling the terminally ill?”
And I don’t think you answered my question about specifically what services a chaplain provides that a normal counsellor / therapist cannot, or maybe even a Doctor or Nurse who is a good listener?
Sorry about the name change, I used the wrong log in last night 🙂
Yes, *counselling* is an aspect of psychological care (how do you do italics on this thing?). But there are other forms of support and help that aren’t formal counselling. Classic counselling would use Rogerian person-centred techniques, or more recent approaches such as CBT or psychodynamics. While chaplains may be skilled in any or all of those, what we do isn’t counselling. It’s more usually what might be called committed companioning, although even a term like that doesn’t really cover it. We’re very often called on to deal with issues around ethics and relationships. Another common area of work is around “biographical pain” – sorry to quote Tony Walter again, but he defines this as “the sense that my life hasn’t added up the way I would have wanted, and that it’s now too late to change it.” Helping people with decisions around accepting or continuing treatment also often come to the chaplaincy team, and chaplains have to have up-to-the-minute skills in the legal and ethical aspects of end of life care.
I don’t deny that there will be some overlap with counsellors, or with others – we might use techniques that complementary therapists would use around concepts such as mindfulness and meditation, for instance. Defining a chaplain’s skills is a bit like the old exercise of defining a “homemaker”. There’s nothing a homemaker does that couldn’t be done just as well by a cook, cleaner, secretary, accountant, childminder … (I’m sure you’re familiar with the idea.)
Nurses, in fact, became very interested in spiritual care about 20-25 years ago, and there was a lot of good literature coming out of the nursing profession on the subject. But as a profession, they’ve largely backed off because they found that the time commitment and acquisition of extra skills was just too much on top of everything else they had to do.
Every time you respond to a comment, I feel you are moving the goalposts.
Again you imply that this is a unique service being provided by the chaplaincy but all I can see is a combination of what Doctors, Nurses and counsellors are already doing (or should be doing). You have now shifted to suggest that it is a case of taking up the slack of the humanitarian aspect of the healthcare service.
Can I return to a previous point I made – why is there a required religious qualification for this role? Isn’t then, the £29m p.a. better spent on health practitioners (perhaps counselling) practising universal skills that do not require a religious element that you say the chaplaincy are not providing anyway?
This strikes me as the old and contradictory defence of foxhunting “we are providing a service of keeping the population down… but we don’t kill very many, mostly the sick and lame”. Not that I am against foxhunting, it is just an argument I have seen used time and again and it is an argument I feel to be very poor.
Can anybody explain why it makes sense to keep funding religious groups for secular a service we are already getting while still requiring a religious qualification to provide it?
I’m afraid I haven’t much time for posting today, but I’d like to say something about this –
“Can I return to a previous point I made – why is there a required religious qualification for this role?”
There isn’t one. Never has been. It’s another common misconception about chaplaincy. What there is, is the right of every patient to be seen by someone of their own tradition. I would also expect to see in a job advert that candidates should have some sort of accreditation from whatever group they represent. But there have been humanist chaplains around for several years.
Dept of Health guidelines in 2003 suggest that chaplaincy staffing level should be divided up proportionately according to which faith groups the patients identify with. That principle continued in force until equal opportunities legislation gave us more freedom to employ the best candidates regardless of faith/philosophy. Nevertheless, it still makes sense to try and balance the team so that patients can be seen by someone who has the same spiritual, philosophical and cultural vocabulary as themselves.
A problem we’ve got with regard to non-religious worldviews is that the vast majority of hospital patients still identify with a faith. Where I work, the figure is usually upwards of 85%, and of the remainder, around 10% is “unknown” or “did not disclose”. We keep contact details on file of someone from the BHA who conducts humanist ceremonies, as our contact for humanist chaplaincy – but in the 7 years I’ve been in post at my current job, nobody’s ever asked to see them.
If you want to know more, try searching for ‘Marie Curie spiritual care competencies’ (without the quotes) – some of the best work in the field has been done by Marie Curie Cancer Care.
Chiron is incorrect.
There is a requirment for Chaplains to have a religious qualification.
Perhaps not for volunteers, but certainly for NHS funded chaplains.
Check the Person Specification on any Chaplain job advert.
I have posted my response to Hospital Chaplains on my blog:
http://www.edwardpresswood.com/1/post/2012/04/hospital-chaplains.html
Thanks for your comment, Edward. It got caught in the spamfilter for some reason, but I’ve just found and retrieved it.
I’ll see if Chiron wants to come back and respond to your first point, as there seems to be a difference on a basic matter of fact, which it ought to be possible to straighten out.
And thanks for linking to your blog, which gave a well-argued response. I particularly liked the questions at the end, which were very thought-provoking. My position, as someone who is basically secularist, is a somewhat pragmatic one. I believe that there are times when it’s reasonable, rational and liberal to allow for the fact that many people have beliefs, and find some way of reflecting that. But the question of how to do that in a way that’s balanced and fair to everyone is tricky. In this case, I’m not sure if there’s a simple right answer – if all Chaplains have to be employed/paid for by religious bodies, for example, it may make it much harder to control the religious excesses you fear. If they’re employed by the NHS, they can be sacked for evangelising to patients. If not, then what?
Your questions raise some important issues, the strongest point (I think) being on which religions should be supported. In fact, from my pragmatically-based standpoint, that’s a very strong argument. There are bound to be gaps in the provision for those with minority beliefs, and that being the case, the obvious solution is to have some sort of generic counselling/support service for those cases. If that’s good enough for some beliefs, why not all?
I think you may be winning me round, but even so, I doubt this is ever going to be an issue I feel like manning the barricades over in either direction.
I think there’s a tricky equation to square in this case. I understand concerns that public money’s being used to provide a religious presence in hospitals – it’s a concern that I would share in general. But I think it gets much more complicated where that religious presence is part of a broad picture of counselling and support.
If it’s the role of the NHS to provide counselling in difficult or stressful situations (as I believe it is), what purpose does that counselling serve, and what form should it take? I see it as meeting the needs of the person in what is most likely a life-changing moment. So shouldn’t that support meet those needs, whatever they are, rather than delivering a one-size-fits-all generic counselling service and expecting those needs to fit around what’s on offer?
Of course, there’s a balance to be struck. I share Chiron’s view that there should be more Humanist chaplains, and I also think it’s important to put clear limits on the roles of chaplains, to avoid a sort of mission creep. But I can’t see chaplains as a major issue, and I certainly think it’s a lot more complicated than the public debate tends to suggest.
That’s a good point about mission creep, Recovering Agnostic, and I agree entirely. I think part of the problem of contemporary chaplaincy is that we can be seen as generally helpful dogsbodies, and I’m sure that there are places where staffing levels and staffing costs are too high. Personally I’d like to see partnership agreements with religious groups, so that those groups do contribute *some* (probably a minority) of the cost. But my point is that NHS funding is vital not only to maintain universal access to the service, but to ensure accountability, good governance, and those other functions of chaplaincy such as being an ethical resource.
I work in a hospital and am one of the people who walk in hurriedly and can only spend a few minutes with the patient and their family members.I work in a private hospital and don’t have to worry about public funding.
Death is a common occurrence in medicine and so the need to counsel the patient and family is of paramount importance. Even though I believe in no deity, it does not mean that I view a sick person as mentioned in the post ” If you believe that a sick person is qualitatively no different from a broken car engine”. I agree that a sick person should receive top-quality biomedical care, and this care should include counseling by trained professionals. This must include psychological therapy.
Where I work there are no hospital chaplains, rather a service called Medical Family Therapy that is composed of psychologists and thanatologists who give patients and their families very good assistance in dealing with their anxieties and decisions, in an inevitable situation. They help achieve the most important thing…acceptance. They day we are born, starts the path to the only certainty we have, and that is death, as some have the ability to avoid taxes. We must all embrace the fact that life is only for a limited time, so we must do our best to make the most of it.
I must add that the hospital where I work has a very large religious population of mostly Jewish and Catholic faith. Each denomination tends to its own members and are permitted to assist the patient and the family, but are not part of the hospital staff. We also have a small chapel and synagogue in house where whoever feels like it may go to religious services or just go and pray.
A pair of hands involved in work do much more than those involved in prayer…but to each his own I guess.
The question I have to make is about the qualifications that the chaplains have professionally speaking. Are they trained to be more than a sympathetic listener? And this goes for religious chaplains as well as Humanist chaplains [sic]. Are these persons not better served by professionals ?
And regarding the term Humanist chaplains, it may be semantics, but a chaplain by definition is associated to religion and is in direct contrast to the the IHEU Minimum Statement on Humanism: “Humanism is a democratic and ethical life stance, which affirms that human beings have the right and responsibility to give meaning and shape to their own lives. It stands for the building of a more humane society through an ethic based on human and other natural values in the spirit of reason and free inquiry through human capabilities. It is not theistic, and it does not accept supernatural views of reality”.
Why not call them Humanist counselors?
As far as I’m concerned, you can call them what you like. What interests me is whether there can be a legitimate place within hospital-based counselling and support for a religious or spiritual element. This is a rather strange experience for me, as I’m usually on the other side of this sort of argument, but I think it does have a place, because like it or not, people often (mostly, even) have a religious or spiritual element.
I often hear the argument that certain secular policies are “imposing secularism” on everyone. I heard it a lot over the Bideford Town Council prayers, where expecting people to be able to perform their duties as councillors without having to participate in religious acts was somehow ludicrously portrayed as an imposition. I hate that sort of self-absorbed argument with a passion, but in this case, I can’t help thinking that it would have some validity.
If you’re providing counselling and support for patients and families, especially within the NHS, you should provide it to all. In that case, there are two options: either provide a generic service, offering exactly the same to everyone, or have a variety of options, including both religious and secular support, to cater for people’s differing beliefs, needs and personalities. If that can be achieved for the same cost as a generic service (I’m not aware of any hospitals which are so small that a varied service is entirely unfeasible), I think it would be reasonable and beneficial to provide it. But if you could provide it and choose not to – to enforce a generic secular standard – it does seem to be straying into imposition.
Of course, there are plenty of conditions and qualifications in the above, and I think there should be limits and ground rules – it’s a difficult and emotive area to handle, which is probably why successive governments have been determined to keep their heads down and hope the problem goes away – but I’m perfectly happy with the principle that a hospital can provide religious chaplains for those who want them, just as I’m happy for hospitals to provide any number of treatments that I don’t want and can’t imagine ever wanting, whatever my state of health. If they provide a cost-effective benefit to some people, they’re surely worthwhile, whatever any particular person feels about them.
I aggree with you, everybody should recieve the same generic service, provided by professionals. If somebody feels the need for religious counseling, they should be free to seek it, but not at the taxpayers cost.
I look forward to reading your future posts and comments.
Here in Australia we are in the middle of a debate about government funding of chaplains in schools. The debate has raised a number of the same issues as raised in the post and comments above. Originally the program only funded religious chaplains. Participation by a school was voluntary, but the program had such a huge take up rate that there was a shortage of chaplains and the amount originally allocated soon ran out. Given the demographic of Australia the vast majority of chaplains were Christian – although there were some Buddhist and Islamic chaplains appointed as well. However the program soon ran into problems as various chaplains were accused of prostrating and those of no belief objected to their children being exposed to a Christian chaplain. The program is currently the subject of a High Court challenge as to its constitutionality. Since then the program has been modified. Chaplains can now come from a faith community or none. These none religious chaplains are called Secular Pastoral Care Workers and fulfil he same role as a chaplain.
There seems to be two main reasons for modifying the program rather than scrapping it and employing councillors instead. First the chaplains are cheaper and there is a shortage of councillors. But that does not seem to be the main reason. There have been two government inquiries, a privately funded study and two theses on chaplaincy (although some of these refer to the privately funded arrangements prior to the government program) One of the findings familiar to all of these studies is that chaplaincy reaches children that councillors don’t. There is a certain stigma attached with ‘going to see the councillor’ and I can imagine that there may be a similar reluctance in a hospital setting. For good or ill councillors and psychologists can have a stigma associated with them and for some this stigma may prevent them seeking the help they need. There is a perception that a councillor or physiologist will ‘diagnose’ them or that they have to be really badly off to need to see such a professional. The studies in Australia suggest that (at least in the schools setting) students are more likely to go and see the chaplain for a chat. The chaplain can then be a listening ear and act as a first port of call for the welfare team The chaplain can refer the student off to the appropriate professional, but the key is to get the student to talk to someone –anyone. If they feel more comfortable with a chaplain (be they religious or non-religious) then that at least gets them in the door and talking to the welfare team.
I will add two things. First the research I have referred to refers to chaplains in schools and the program has not been without its problems. Second In Australia hospital chaplains are funded by local faith groups rather than the state. The system seems to work fairly well but it does mean that the provision of chaplains is very dependent on the ability of the local faith communities to raise funds. In poorer neighbourhoods this can mean the local hospital has to go without a chaplain altogether or rely on the voluntary time of local religious leaders and lay people who go on ‘hospital visits’.
Great comments.
My reply to this article can be found on my blog:
http://www.edwardpresswood.com/1/post/2012/04/hospital-chaplains.html
I am a Humanist chaplain and ceremonies celebrant.
I am writing to NHS Hospitals who do NOT acknowledge their many non-religious patients in their Pastoral Care Services. It would seem from your chaplaincy section of your website that there is no provision for appropriate pastoral care for your many non-religious patients and their families. By stating: We are here to support people of any faith or none does NOT make it an inclusive service.
This is what the British Humanist Associations states: The BHA receives two types of requests for support and advice in relation to chaplaincy. The first type of enquiry is from those who have been inappropriately approached by religious chaplains in environments such as hospitals or colleges. The second is from those who are seeking a humanist equivalent to chaplaincy, often in hospitals and at the end of life, in prisons, universities, or closed professional settings such as the armed services.
Mental health and wellbeing is an important part of general health and wellbeing and the BHA supports the provision of inclusive and secular counselling services where appropriate as a part of the public health system, including in prisons, hospitals and closed settings such as the armed services. The BHA does not support the provision at public expense of religious chaplaincy and believes that where such chaplaincy is available in public contexts it should be requested before it is provided.
The BHA has an informal network of humanists who are working to provide humanist pastoral and moral support and advice in hopsitals. Some hospitals/hospices have been more responsive in recognising that non-religious people may need emotional, psychological existential care or moral support from those with a similar non religious/humanist outlook. Whatever it is called, pastoral care specifically for the non-religious needs to give advice and reassurance on an existential level, helping with questions relating to belief and ethics and to a persons lifestance with someone with a similar outlook. When I am contacted by the head of Chaplaincy at King’s College Hospital he says. Another ‘no dog collar’ request. My experience is that the people I have visited in hospital/hospice have wanted to speak about their funeral and to acknowledge their philosophical view of life and ethics with someone of a similar outllook who does not believe in the supernatural/afterlife but have tried to lead good and happy lives.
At a time when the NHS is under threat the needs of all patients have to be addressed.